Healthcare Provider Details

I. General information

NPI: 1710104963
Provider Name (Legal Business Name): DENIZ SIDALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST FL 2
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

9411 59TH AVE APT C20
ELMHURST NY
11373-5103
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax: 212-420-1906
Mailing address:
  • Phone: 718-592-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: